Comparative analysis of suicide trends and patterns in northern and southern Tunisia: a five-year autopsy-based study

BACKGROUND: While Tunisian suicide rate have risen since the 2011 revolution, data remains sporadic and regionally limited. To date, no comparative studies have examined cross-regional mortality trends. This study aimed to compare patterns and temporal trends between northern and southern regions, and to identify factors associated with the most prevalent method of suicide. METHODS: Cross-sectional study conducted over a five-year period (2020-2024). Data were retrospectively collected from the autopsy reports. Variables included demographic characteristics, medical history, as well as circumstances and potential triggers. RESULTS: In total, 258 cases were analysed, with an almost equal distribution between the two regions. Suicide mortality exhibited a significant upward trend, reaching 4.51 per 100,000 in the north and 3.45 in the south. A notable upward pattern was observed in the north (R2 = 97%), whereas the southern region exhibited only a sporadic increase in 2021 (R2 = 2.7%). Mental disorders were the leading reported trigger in the north. Hanging was the predominant method in both regions. Suicides occurring at home were significantly associated with hanging. Substance abuse or mental disorders documented cases were less likely to involve hanging. CONCLUSION: Reducing suicide mortality requires targeted prevention and improved mental health services tailored to regional and clinical drivers.